Bottom Line:
Statistically significant interactions between processes of care and parent variables highlight the complexity of real life situations.Conclusions.A multitude of factors and interactions between these factors are simultaneously present and the care of these families requires a holistic approach.

ABSTRACTPurpose. To explore the associations and interactions among ecological factors and explain the psychosocial quality of life of children with complex needs. Methods. In this cross-sectional survey consenting parents were identified by the Children's Treatment Network. Families were eligible if the child from 0 to 19 years, resided in Simcoe/York, and there were multiple family needs. Regression analysis was used to explore associations and interactions. n = 429. Results. Younger children, without conduct disorder, without hostile and punitive parenting and with low adverse family impact demonstrated the highest levels of psychosocial quality of life. Statistically significant interactions between processes of care and parent variables highlight the complexity of real life situations. Conclusions. It is not possible to fully understand the child's psychosocial quality of life in complex needs families by considering only simple associations between ecological factors. A multitude of factors and interactions between these factors are simultaneously present and the care of these families requires a holistic approach.

fig1: Bioecological model of key factors and their interactions with child psychosocial function.

Mentions:
Specifically, children with complex needs experience a constellation of physical limitations and behaviours over time (age) and interact within their environment (parent, family, school, social and health providers) (Figure 1). Concurrently, parents may have their own social/emotional/physical issues yet they must respond to and live with the child's behaviour in addition to physical limitations as the child develops (this is the essence of parenting). Family, school and treatment providers also respond to the child and parent involving them in a complex interplay of environmental factors. We hypothesize that the reciprocal influence between the child's behavior, their immediate parenting/family environments, parent report of impact on the family, parent depression/anxiety and well-being, and family function influences the child's psychosocial function. Supportive and comprehensive processes of care from health care providers may help to influence child psychosocial function when parents exhibit poor physical or mental health, and family outcomes. A better understanding of the interplay among these variables would help highlight the emphasis to be taken in child and family rehabilitation if the objective is to maximize the child's quality of life (physical and psychosocial) and promote the family's ability to live with their child's disability [12]. Further, an understanding of the service provider processes of care that influence the child's psychosocial quality of life when the child, parent or family have additional psychosocial circumstances and behaviours would offer specific guidance to providers. As stated so clearly by Koroloff and Friesen [13] “family strength and family focused models and perspectives embraced by current service delivery demand new research approaches.”

fig1: Bioecological model of key factors and their interactions with child psychosocial function.

Mentions:
Specifically, children with complex needs experience a constellation of physical limitations and behaviours over time (age) and interact within their environment (parent, family, school, social and health providers) (Figure 1). Concurrently, parents may have their own social/emotional/physical issues yet they must respond to and live with the child's behaviour in addition to physical limitations as the child develops (this is the essence of parenting). Family, school and treatment providers also respond to the child and parent involving them in a complex interplay of environmental factors. We hypothesize that the reciprocal influence between the child's behavior, their immediate parenting/family environments, parent report of impact on the family, parent depression/anxiety and well-being, and family function influences the child's psychosocial function. Supportive and comprehensive processes of care from health care providers may help to influence child psychosocial function when parents exhibit poor physical or mental health, and family outcomes. A better understanding of the interplay among these variables would help highlight the emphasis to be taken in child and family rehabilitation if the objective is to maximize the child's quality of life (physical and psychosocial) and promote the family's ability to live with their child's disability [12]. Further, an understanding of the service provider processes of care that influence the child's psychosocial quality of life when the child, parent or family have additional psychosocial circumstances and behaviours would offer specific guidance to providers. As stated so clearly by Koroloff and Friesen [13] “family strength and family focused models and perspectives embraced by current service delivery demand new research approaches.”

Bottom Line:
Statistically significant interactions between processes of care and parent variables highlight the complexity of real life situations.Conclusions.A multitude of factors and interactions between these factors are simultaneously present and the care of these families requires a holistic approach.

ABSTRACTPurpose. To explore the associations and interactions among ecological factors and explain the psychosocial quality of life of children with complex needs. Methods. In this cross-sectional survey consenting parents were identified by the Children's Treatment Network. Families were eligible if the child from 0 to 19 years, resided in Simcoe/York, and there were multiple family needs. Regression analysis was used to explore associations and interactions. n = 429. Results. Younger children, without conduct disorder, without hostile and punitive parenting and with low adverse family impact demonstrated the highest levels of psychosocial quality of life. Statistically significant interactions between processes of care and parent variables highlight the complexity of real life situations. Conclusions. It is not possible to fully understand the child's psychosocial quality of life in complex needs families by considering only simple associations between ecological factors. A multitude of factors and interactions between these factors are simultaneously present and the care of these families requires a holistic approach.